The Epistemonikos Foundation team has coined the term Sustainable knowledge to describe knowledge that is produced under optimal conditions of quality, efficiency, and minimal redundancy. 

This issue of our newsletter presents a summary of an article recently published by our team in the Journal of Clinical Epidemiology, titled “Framing Evidence Synthesis Production with the Lens of Sustainable Knowledge”. The article argues that evidence synthesis is undergoing a profound crisis and proposes sustainable knowledge as a conceptual framework for understanding and addressing this challenge.

Access the full text article (open access):Rada G, Ávila-Oliver C, Pesce F, Verdugo-Paiva F. Framing evidence synthesis production with the lens of sustainable knowledge. J Clin Epidemiol. 2025 Oct 27;189:112027. doi: 10.1016/j.jclinepi.2025.112027

 

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The need for trustworthy evidence

Every day, people working in healthcare make decisions that directly affect lives: clinicians choose treatments, public health teams respond to emergencies, and policymakers design programs that shape population health. Ideally, these decisions should rely on the best and most reliable scientific evidence available. Yet the rapid and continuous growth of scientific publications makes it increasingly difficult to find, interpret, and keep up with new information.

Systematic reviews were created to help address this challenge. By gathering all available evidence on a specific question, assessing its quality, and summarizing what is known (as well as remaining uncertainties), systematic reviews provide a structured and transparent foundation for evidence-based decisions. For this reason, they have become the gold standard in healthcare decision-making.

However, despite their importance, systematic reviews are now facing a rapidly growing crisis.

A system under strain

Systematic reviews were designed to make research more accessible, but their success has produced an unintended consequence: explosive growth. In health sciences alone, more than 200 new systematic reviews are published every day, sometimes even outnumbering the publication of new primary studies about the same topics. With so many reviews available, users often struggle to identify which one is the most trustworthy and up to date.

Worse still, many of these reviews suffer from major weaknesses. Some are poorly conducted, others repeat work that has already been done, and many quickly become outdated. The process of creating a high-quality review is long and complicated, often taking more than a year, and requires expertise, resources, and careful methodological work. Given the pace of scientific discovery, a review may already be obsolete by the time it is published.

Our team points out that these problems are not simply due to technical challenges. They reflect deeper issues in the research ecosystem: academic incentives that reward quantity over quality, limited funding, fragmented data systems, and research teams working in isolation. Together, these factors generate redundancy, inefficiency, and persistent gaps in the evidence base.

New approaches and why they are not enough

To address these challenges, researchers have introduced new types of evidence syntheses. Rapid reviews aim to speed up the process by simplifying certain steps. Living reviews aim to remain continuously updated as new evidence emerges. Both approaches increasingly rely on technological tools to support tasks such as study screening or data extraction.

Although promising, these innovations have not resolved the underlying crisis. Rapid reviews often trade quality for speed. Living reviews are difficult and costly to maintain, leading many to be updated only once, or never, despite being labeled “living.” Technological tools, while powerful, face skepticism regarding transparency and reliability, and in many cases remain inaccessible to some teams.

Even exemplary initiatives reveal the limits of the current system. Some reviews achieve exceptional rigor but take years to complete. Others update frequently but lack methodological depth. The large-scale collaborations seen during the COVID-19 pandemic demonstrated what coordinated efforts can achieve, but they required extraordinary conditions that are not sustainable under normal circumstances.

In the article, our team included several examples where reviews excelled in one area (quality, efficiency, or coordination) but still struggled in others. This highlights that improving isolated parts of the process is insufficient. The barriers run deeper, and the solutions must address the system as a whole.

A new lens: sustainable knowledge

To move forward, our team proposes sustainable knowledge as an integrative framework. This refers to knowledge produced under the best possible conditions of:

1. Quality: the use of robust, low-bias methods and the continuous updating of evidence.

2. Efficiency: delivering timely results while using resources responsibly.

3. Minimal redundancy: preventing unnecessary duplication without hindering essential replication.

Current efforts often focus on one dimension at a time. For example, emphasizing speed at the expense of quality or prioritizing rigor at the cost of timely updates. A sustainability-centered perspective recognizes the need to balance all dimensions simultaneously, supported by modern technologies and stronger collaboration.

It is important to reduce unnecessary duplication. During the COVID-19 pandemic, many groups coordinated efforts to avoid repeating the same tasks, demonstrating what is possible when incentives align. Under typical conditions, however, research teams tend to work in isolation, leading to multiple reviews on the same topic.

Interoperability is a key driver of sustainable knowledge: the ability of data, software, and systems to work together seamlessly. Today, evidence is scattered across numerous sources, presented in inconsistent formats, and often hidden behind paywalls. A sustainable system requires open science, shared standards, and platforms that enable efficient collaboration.

Finally, reforming academic incentives is crucial. Researchers are often rewarded for producing as many publications as possible, encouraging quantity rather than quality. Shifting incentives toward meaningful contributions, collaboration, and openness would help realign the system with its core mission: improving health decision-making.

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How Epistemonikos contributing to sustainable knowledge

At the Epistemonikos Foundation, we are fully committed to advancing the transformation we propose. To support this goal, we have developed the Sustainable Knowledge Platform (SKP), designed to facilitate evidence synthesis that balances high quality with efficiency. SKP enables rapid and rigorous production of evidence, including the use of artificial intelligence and other technologies, and can minimize redundancy through reuse of data and coordination between researchers. 

We are also developing a more ambitious initiative: the Sustainable Knowledge End-to-End system, the first system covering every step of evidence synthesis, from question formulation to dissemination of findings.

The Sustainable Knowledge Platform is now being pilot tested by different organizations, and its formal release is planned for April 2026. 

🔗 Useful links:
Read more about The Sustainable Knowledge Platform. 

Are you interested in using SKP for your project? Contact us here.

Read more about the Sustainable Knowledge End-to-End system.